What Is A Major Medical Insurance Plan?

by | Last updated on January 24, 2024

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A major medical plan is a

type of plan that meets all of the minimum essential benefit standards of

the Affordable Care Act (ACA or “Obamacare”). It also provides benefits for a broad range of inpatient and outpatient health-care services.

What is a qualified major medical plan?

Major medical health insurance plans are the type of insurance people are referring to when they talk about typical

health insurance coverage

. These comprehensive plans comply with the ACA's regulations for qualifying and are designed to minimize out-of-pocket expenses for individuals and families.

What type of insurance is major medical?

Major medical health insurance is a

type of health insurance

that covers the expenses associated with serious illness or hospitalization. Major medical health insurance is the terminology that was historically used to describe comprehensive health plans that covered most necessary care.

How is a major medical policy premium determined?

Premiums tend to be lower than unsubsidized major medical plans because they include less coverage. Your premium is based on many factors,

including your health status and the benefit level you select

. Get a quote to find out if short term policies are available in your area and compare costs and coverage options.

What is major medical insurance designed to protect against?

Major medical plans are a special type of fee-for-service plan. They are designed to provide protection against

long-term chronic or catastrophic illness or injury

. These plans cover a broad area of health care services and are designed to protect against large medical expenses only.

What are major medical expenses?

It covers a large amount of possible financial expenses including

hospital room and board

, hospital extras, nursing services in-hospital or at home, blood, oxygen prosthetic devices, surgery, physician's fee, ambulance services, and more. Major medical provides high benefit limits.

What is a basic medical plan?

Basic Plans

A basic plan usually includes

the everyday costs of medical treatments

; like hospital stays, surgeries and emergency treatment. In most instances, these plans pay one hundred percent of cost; however, there could be a payment limit. This leaves the individual to cover the balance.

What is a major medical deductible?


The amount you pay for covered health care services before your insurance plan starts to pay

. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.

How do I find out my deductible?

A deductible can be either a specific dollar amount or a percentage of the total amount of insurance on a policy. The amount is established by the terms of your coverage and can be

found on the declarations (or front) page of standard homeowners and auto insurance policies

.

What are qualified health insurance premiums?

“Qualifying premiums” means

the net sum of moneys that is payable under a VHIS policy to the insurer for writing or renewing the policy in so

far as it relates to the insurance plan certified by the Secretary for Food and Health to be in compliance with the Government's VHIS.

Which type of coverage pays an amount per day for hospitalization?


A hospital indemnity policy

pays an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance. Kim has health insurance with a deductible of $500 and an 80/20 coinsurance.

What is a major medical adjustment?

insurance designed to compensate for particularly large medical expenses due to a severe or prolonged illness, usually by paying a

high percentage of medical bills above a certain amount

.

What is the difference between health and medical insurance?


Healthcare

and health insurance are terms that are often used interchangeably. However, healthcare, which typically includes elements like emergency room visits, preventative medicine, and prescription drugs, is far different than health insurance which provides coverage for medical services.

What are the three levels of health insurance coverage?

Levels of plans in the Health Insurance Marketplace®:

Bronze, Silver, Gold, and Platinum

. Categories (sometimes called “metal levels”) are based on how you and your insurance plan split costs. Categories have nothing to do with quality of care.

What does comprehensive major medical insurance cover?

A comprehensive major medical insurance policy covers

the major portion of the charges incurred during hospitalization

. Depending on your insurance provider and your policy, coverage may include expenses for the pre-admission diagnosis, which include payment to the medical specialist, lab work, exams and X-rays.

What is a hospital income insurance policy?

Hospital Income Insurance —

insurance providing a stated weekly or monthly payment during the hospitalization of the insured

. The benefits payable are not based on the actual expenses incurred.

James Park
Author
James Park
Dr. James Park is a medical doctor and health expert with a focus on disease prevention and wellness. He has written several publications on nutrition and fitness, and has been featured in various health magazines. Dr. Park's evidence-based approach to health will help you make informed decisions about your well-being.